Cervical Stump Fibroid: Approach to Trachelectomy of a Dilated Cervix

Study Objective

To highlight preoperative and intraoperative strategies that can facilitate a safe and uncomplicated trachelectomy when the cervix is dilated.

Design

Surgical video of a single patient with symptomatic 9cm cervical stump fibroid who underwent laparoscopic trachelectomy.

Setting

Surgery was performed in the operating room with patient in dorsal lithotomy and Trendelenburg positioning to enable successful laparoscopy.

Patients or Participants

Single case study of a 48 year old female presenting with pelvic pressure and irregular spotting in the setting of a prior supracervical hysterectomy performed for AUB-L. Patient was found to have a 9cm cervical stump fibroid on imaging with evidence of dense adhesions to the anterior abdominal wall and bowel.

Interventions

Patient underwent laparoscopic lysis of adhesions, ureteral stenting, extensive enterolysis, appendectomy, and trachelectomy, with successful removal of the cervical stump with the fibroid en bloc.

Measurements and Primary Results

Patient tolerated the procedure well, and recovered well postoperatively with complete resolution of presenting symptoms.

Conclusion

This case study highlights key preoperative and intraoperative strategies that enabled this successful trachelectomy of a dilated cervical stump.